The Reflective Fostering Programme-Adapting a group parenting programme for online delivery in response to the COVID-19 pandemic in the United Kingdom.

OBJECTIVE: In the context of the Covid-19 pandemic and subsequent lockdown restrictions, service providers faced significant challenges in delivering programmes to support their vulnerable service users. Foster carers-an already often isolated group of caregivers - were offered an adapted remote-delivery model of the Reflective Fostering Programme (Redfern et al., Adopt. Foster., 42, 2018, 234) from March 2020. METHOD: This paper outlines the adaptation process of the original programme to online-remote delivery and describes the feedback from participants in the programme. RESULTS: The adaptation of the Reflective Fostering programme to online, remote delivery had both strengths and weaknesses - including wider access to foster carers who might struggle to attend in person and challenge a to maintaining a Mentalizing space online and ensuring confidentiality within a therapeutic space. The programme was overwhelmingly well received by foster carers in this format. CONCLUSIONS: There are opportunities and challenges in the delivery of online therapeutic services, particularly those with a group format. This paper contributes initial reflections to what we hope will be a rapidly developing literature on best practice of supporting group services in an online format.

Mapping the journey from epistemic mistrust in depressed adolescents receiving psychotherapy.

Although the theory of epistemic trust has started informing research in clinical populations and psychotherapy, no study has yet explored the phenomenon of epistemic trust and mistrust in depressed adolescents receiving psychotherapy. The present study aims to address this gap by creating a typology of depressed adolescents' experiences regarding their different journeys through the course of psychotherapy in relation to issues of epistemic trust and mistrust over a 2-year period. This study is based on a post hoc analysis of interview data collected for a broader purpose. A total of 45 semistructured interviews at three time points were conducted with 15 adolescents (80% female; Mage = 15.28, SD = 1.79) who entered treatment with indications of epistemic mistrust or hypervigilance. These interviews were qualitatively analyzed using ideal type analysis. Three distinct journeys of adolescents' experiences were identified. Some experienced a shift from epistemic mistrust to epistemic trust which seemed to be associated with the experience of therapy; other adolescents also showed a shift but did not consider it as an outcome of therapy; and finally, some adolescents reported continued mistrust over the 2-year period. An interpersonal component within or beyond therapy may be the key to breaking the vicious cycle of epistemic mistrust and generating epistemic trust; but not all depressed adolescents in therapy achieve this. Particular attention should be drawn to depressed adolescents who have difficulty making use of therapy and/or their broader social environment. Psychological interventions may need to openly address their issues of mistrust in early sessions as epistemic mistrust or hypervigilance may hinder paths to learning both within and beyond therapy. Treatments that intervene at the level of the wider social system are encouraged. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Reflective Fostering Programme-improving the wellbeing of children in care through a group intervention for foster carers: a randomised controlled trial.

BACKGROUND: The needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer's reflective parenting, may be an effective approach to improving the wellbeing of these children. METHODS: The study comprises a definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost-effectiveness, of the Reflective Fostering Programme. Randomisation is at the individual level using a 1:1 allocation ratio. The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged 4 to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional wellbeing of the child 12 months post-baseline, and secondary outcomes include the following: foster carer's level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child's capacity for emotional regulation, and achievement of personalised goals set by the carer. DISCUSSION: A feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers. TRIAL REGISTRATION: ISRCTN 70832140 .

Greater Response Interference to Pain Faces Under Low Perceptual Load Conditions in Adolescents With Impairing Pain: A Role for Poor Attention Control Mechanisms in Pain Disability?

Persistent pain in young people in the community is common, but individuals vary in how much pain impacts daily life. Information-processing accounts of chronic pain partly attribute the fear and avoidance of pain, as well as associated interference, to a set of involuntary biases, including the preferential allocation of attention resources toward potential threats. Far less research has focused on the role of voluntary goal-directed attention control processes, the ability to flexibly direct attention toward and away from threats, in explaining pain-associated interference. Using a visual search task, we explored a poor attention control account of pain interference in young people with persistent pain from the community. One hundred and forty five young people aged 16 to 19 years were categorized into three groups: non-chronic pain (n = 68), low-interfering persistent pain (n = 40), and moderate- to high-interfering persistent pain (n = 22). We found that only adolescents with moderate-to high-interfering persistent pain but not the other two groups of adolescents were affected by a search task preceded by a pain face (compared to a neutral face), but this within-group difference emerged only under low perceptual load conditions. Because low perceptual load conditions are thought to require more strategic attention resources to suppress the interfering effects of pain face primes, our findings are consistent with a poor attention control account of pain interference in young people. Analyses further showed that these differences in task performance were not explained by confounding effects of anxiety. If replicated, these findings may have implications for understanding and managing the pain-associated disability in adolescents with chronic pain. PERSPECTIVE: Young people with moderately and highly interfering pain responded slower on an easy search task after seeing a pain face than after seeing a neutral face. If replicated, these findings could mean that boosting the ability to control attention toward and away from threatening cues is an effective strategy for managing interference from pain.